Provider Demographics
NPI:1013217553
Name:BUONO, PAMELA J (MS,RD,CDN,CDE)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:BUONO
Suffix:
Gender:F
Credentials:MS,RD,CDN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CONNELLY RD
Mailing Address - Street 2:
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466-5013
Mailing Address - Country:US
Mailing Address - Phone:845-334-9388
Mailing Address - Fax:
Practice Address - Street 1:55 CONNELLY RD
Practice Address - Street 2:
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466-5013
Practice Address - Country:US
Practice Address - Phone:845-334-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered